Hodgkin Lymphoma: Addressing the Elderly Population

Stephen M. Ansell, MD, PhD: Elderly patients that have classical Hodgkin lymphoma have been a particularly challenging population of patients to treat. ABVD chemotherapy, which is a standard approach, is actually very poorly tolerated in older people. And in fact, bleomycin lung toxicity is a substantial issue. If you looked to see how many people could complete the treatment, and how well or not they did, most elderly patients do not do particularly well with this combination. So, this phase II trial by Evens was really trying to build on some of the new and exciting data with new agents–in this case, brentuximab vedotin–in combination with AVD chemotherapy, omitting bleomycin, which is the agent which causes lung toxicity.

In this trial, patients received 2 doses of brentuximab vedotin first. Then they received AVD chemotherapy for 6 cycles of treatment. Then they received a further 4 doses of brentuximab vedotin on the tail end. This was done with the idea that you would get patients into a remission, consolidate the remission, and then maintain it with a subsequent dose of brentuximab vedotin for 4 months. The results were very encouraging. There were very high response rates, 90% of patients benefiting from treatment. We’re going to need a little longer follow-up for the durability of that, but I think it was really encouraging to say that this combination looks quite promising in elderly patients.
It’s still a little challenging to give this to older people. If one looks at the total number of patients that actually received all of the treatment, it was only about half of the patients. When Dr.

Evens presented the data, he also shared that a number of them required a dose reduction along the way. So, I think we still are going to learn how to give this combination to older patients. But I think the exciting news was this is a promising and tolerated combination for old people.

Radhakrishnan Ramchandren, MD: Certainly, this combined with the ECHELON data suggests that this could be possible. There were patients in the ECHELON data cohort that were older in age. Tolerability has been demonstrated in both of these studies. I think further evaluation is needed to see if this combination is equally tolerable to ABVD, and indeed, confirms the better results in terms of the outcomes that were seen in this smaller study that we are discussing.

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Stephen M. Ansell, MD, PhD: Elderly patients that have classical Hodgkin lymphoma have been a particularly challenging population of patients to treat. ABVD chemotherapy, which is a standard approach, is actually very poorly tolerated in older people. And in fact, bleomycin lung toxicity is a substantial issue. If you looked to see how many people could complete the treatment, and how well or not they did, most elderly patients do not do particularly well with this combination. So, this phase II trial by Evens was really trying to build on some of the new and exciting data with new agents–in this case, brentuximab vedotin–in combination with AVD chemotherapy, omitting bleomycin, which is the agent which causes lung toxicity.

In this trial, patients received 2 doses of brentuximab vedotin first. Then they received AVD chemotherapy for 6 cycles of treatment. Then they received a further 4 doses of brentuximab vedotin on the tail end. This was done with the idea that you would get patients into a remission, consolidate the remission, and then maintain it with a subsequent dose of brentuximab vedotin for 4 months. The results were very encouraging. There were very high response rates, 90% of patients benefiting from treatment. We’re going to need a little longer follow-up for the durability of that, but I think it was really encouraging to say that this combination looks quite promising in elderly patients.
It’s still a little challenging to give this to older people. If one looks at the total number of patients that actually received all of the treatment, it was only about half of the patients. When Dr.

Evens presented the data, he also shared that a number of them required a dose reduction along the way. So, I think we still are going to learn how to give this combination to older patients. But I think the exciting news was this is a promising and tolerated combination for old people.

Radhakrishnan Ramchandren, MD: Certainly, this combined with the ECHELON data suggests that this could be possible. There were patients in the ECHELON data cohort that were older in age. Tolerability has been demonstrated in both of these studies. I think further evaluation is needed to see if this combination is equally tolerable to ABVD, and indeed, confirms the better results in terms of the outcomes that were seen in this smaller study that we are discussing.